MHK CareProminenceTM

Integrated medical and pharmacy management

The only platform that combines pharmacy and medical care, MHK CareProminence was purposely built to improve member care by closing care gaps while ensuring continual compliance with changing government regulations.

Sanders’ Dropping Out Is Good News for Private Health Plans, But It Will Not Mean Transforming the Health-Care System

Sanders’ Dropping Out Is Good News for Private Health Plans, But It Will Not Mean Transforming the Health-Care System

The fact that Bernie Sanders dropped out of the presidential race and backed former Vice President Joe Biden was very much overshadowed by the COVID crisis; however, it was a significant development in the world of health care. The fact is that the two leading presidential candidates now are firm backers of private managed care for our system. That is a major change since the Democratic primary began when the majority of leading contenders supported eliminating private health plans. The looming threat of a Medicare for All single-payer system has receded – at least for now and perhaps for a long time.

Now, despite their support for private health care, Biden and President Trump are not exactly alike in terms of core health policy. The main differences are as follows:

President Trump continues to support rather extreme change in terms of Medicaid and the Exchanges. In the boldest move, Trump would roll back the Medicaid expansion and Exchanges and have states take on the responsibility through block grants.

Biden wants to reform the Exchanges in various ways to provide better stability as well as introduce a public option to compete alongside private plans.

Despite my party affiliation, I support Biden’s view more than I do Trump’s, except for the public option. I fundamentally believe in affordable universal access for all and that it is better to build on the successes we have. I do not see a devolved system getting us to affordable universal access. I also think Republicans should come around to believing that affordable universal access is indeed a social good as it is in every other developed nation of the world. Doing so does not mean adopting a socialist medicine or single-payer system.

So why should health plans be buoyed by the development? Because no matter the election outcome for the White House or Congress, radical change now appears ever so unlikely. Despite some endorsements of Medicare for All, most politicians on each side of the political aisle are major backers of Medicare Advantage (MA).. In the Medicare arena, they see the value that MA has brought in terms of better benefits as well as quality in the system. That stands in stark contrast to the traditional Medicare fee-for-service (FFS) system.

But what about the future of health-care transformation? Will the parties come together to meaningfully change things for the better? This is unlikely given the potential political scenarios coming out of November. Here are the scenarios:

Trump wins re-election and somehow brings both chambers into the Republican column. In this case, Republican leadership might again pursue the same-old devolution strategy. However, remaining moderate Republicans (there would likely be a few in this scenario) and Democrats in the Senate will once again rightly foil those plans. The system remains in place, but still has holes as well as 30 million uninsured Americans.

Trump wins re-election, the Senate barely stays Republican, and the Democrats hold the House. A chessboard stalemate! The Democrats push Obamacare reform and the Senate likely does nothing. The system remains in place, but still has holes as well as 30 million uninsured Americans. A slim chance of potential compromise, but very unlikely.

Trump wins re-election and both houses go Democratic. There could be a slightly better chance of potential reform here. The Democrats push Obamacare reform and the Senate in Democratic hands has enough Democrats and moderate Republicans to somehow pass the measure. The problem is that if Democrats do take the Senate, there are likely almost no moderate Republicans left. The GOP could use their filibuster to stop passage. If it did pass, Trump likely would veto, unless he is in a compromising mood as he was on health issues early on.

Biden wins and carries both Houses. The House pursues Biden’s favored Obamacare reform, the Senate adopts through some procedural maneuvering as in 2010 and Biden signs. The system largely stays in place, with likely a public option and greater premium and cost-sharing subsides. On the regulatory front, Biden rolls back the Trump era tightening on Obamacare to increase enrollment. The rate of the uninsured goes down.

Biden wins, the Senate barely stays Republican, and the House stays in Democratic hands. The House pursues Biden’s favored Obamacare reform. The Senate does nothing. The system remains in place, but still has holes as well as 30 million uninsured Americans. A slim chance of potential compromise.

Although far-fetched, Biden wins and both houses are Republican. No chance of any change. The system stays as is as Biden would veto any Republican initiative.

One could point to a scenario or two above that might be good for America, but by and large the system remains intact, perhaps with some incremental progress. Health plans can reasonably celebrate their continued central position in the health-care system, even as we limp by on the health transformation front in the future as there is no consensus between the parties to take us any further.

Please don’t confuse the above as my hope. These are simply my political prognostications.

Marc S. Ryan serves as MHK’s President and was one of MHK’s first executives shortly after its founding in 2010. Most recently, Marc served as MHK’s Executive Vice President and Chief Operating Officer and before that as its Chief Strategy and Compliance Officer.

Prior to joining MHK, Marc held a number of executive-level regulatory, compliance, business development, and operations roles at a number of health plans. He launched and operated plans with Medicare, Medicaid, commercial and Exchange lines of business.

He also was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program.

Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He was also nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was also inducted into Sigma Beta Delta, a national honor society for business, management and administration.

MHK, part of the Hearst Health network, is a Medical House of Knowledge, where care and knowledge converge. The only service provider that combines pharmacy and medical, MHK’s mission is to drive better member care in a changing healthcare environment by bringing every care moment in a person’s health journey together through an integrated platform. MHK is committed to helping health plans, PBMs, and provider organizations improve quality of care, enhance operational efficiency, maximize revenue, and meet compliance demands. Three of the top five and six of the top ten health plans are served by MHK and forty percent of all 4-5 Star Medicare health plans utilize MHK solutions.